Health Plans Licensed Practical Nurse, LPN Auditor

November 25

🌵 Arizona – Remote

Although this job is listed in Arizona, this company may be open to hiring remote in other states.

💵 $26 - $44 / hour

⏱ Part Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

🦅 H1B Visa Sponsor

Apply Now

Receive Emails with Similar Jobs

Banner Health

WebsiteLinkedInAll Job Openings

Healthcare Insurance

Banner Health is a leading healthcare system committed to making healthcare easier through comprehensive patient services and resources. They provide a safe place for care with services ranging from emergency and urgent care, imaging, and surgery centers to maternity and hospice care. Banner Health also offers telehealth options to ensure access to healthcare, regardless of location. They support athletes through Banner Orthopedics & Sports Medicine and have been recognized for exceptional patient care. With advanced digital tools, they aim to manage healthcare seamlessly for their patients.

10,000+ employees

Founded 1999

⚕️ Healthcare Insurance

📋 Description

• Independently review patient medical charts to assess whether the care provided may have contributed to the cause of death. • Make initial determinations based on clinical findings and documentation. • Forward reviewed charts to the broader Medical Management Team for further evaluation and action. • Assists in the development of clinical medical record audit tools and processes. • Conducts data analysis using Microsoft Excel. • Coordinates, retrieves, and performs medical record audits to determine provider compliance with established AHCCCS standards for documentation. • Monitors and tracks Corrective Active Plans (CAPs), in collaboration with the Manager, Supervisor or QM RN. • Provides written documentation and Corrective Action Plans as directed by the Credentials Committee to providers when necessary. • Reports potential risk or compliance issues identified in the audit process to the Manager/Supervisor of QM. • Coordinates, collects data and prepares monthly provider profile data reports for the Credentialing Department.

🎯 Requirements

• Current, unrestricted State of Arizona LPN license. • Two years of experience, preferably in a family practice or pediatric medical office setting. • Excellent verbal and written communication skills. • Strong collaborative skills (ability to work with a team or individually). • Knowledge and understanding of HEDIS specifications. • Strong leadership skills (can construct a vision, thinks creatively to solve issues and is goal oriented). • Must be knowledgeable of the National Committee for Quality Assurance (NCQA), Health Plan Employer Data Information Set (HEDIS), Arizona Health Cost Containment System (AHCCCS) and Centers for Medicare and Medicaid Services (CMS) standards and reporting requirements.

🏖️ Benefits

• Competitive wages • Paid orientation • Flexible Schedules (select positions) • Fewer Shifts Cancelled • Weekly pay • 403(b) Pre-tax retirement • Employee Assistance Program • Employee wellness program • Discount Entertainment tickets • Restaurant/Shopping discounts • Auto Purchase Plan